Prevention of Dengue Infection

Prevention of Dengue Infection

Dengue, a viral disease transmitted primarily by the ‘Aedes aegypti’ mosquito, is a growing global health concern. The key to preventing dengue infection lies in avoiding mosquito bites, as there is currently no guaranteed cure for the disease. Here’s a comprehensive guide to effective prevention methods.

 

Avoiding Mosquito Bites

The most reliable way to prevent dengue infection is to avoid being bitten by mosquitoes that carry the virus. However, given that dengue is widespread in tropical and subtropical regions—many of which are popular travel and work destinations—completely avoiding such areas is impractical for most people. Instead, the focus should be on personal protection and minimizing mosquito exposure.

1. Use Mosquito Repellents: 

One of the most effective methods of personal protection is the use of mosquito repellents that contain ‘N,N-diethyl-3-methylbenzamide’ (DEET). DEET-based repellents provide long-lasting protection against mosquitoes and should be applied to exposed skin.

2. Wear Protective Clothing: 

Wearing long sleeves and pants can significantly reduce the chances of being bitten. Ideally, the clothing should be treated with ‘permethrin’, an insecticide that repels mosquitoes and other insects. Permethrin-impregnated clothing offers added protection, especially when spending extended periods outdoors.

3. Stay in Well-Screened or Air-Conditioned Areas: 

Mosquitoes thrive in warm, humid environments. Staying in air-conditioned or well-screened rooms can limit exposure to mosquitoes. Ensuring that windows and doors are covered with intact screens helps prevent mosquitoes from entering living spaces.

4. Limited Use of Mosquito Nets: 

Since ‘Aedes’ mosquitoes are primarily active during the day, the use of mosquito nets, while helpful at night, has limited effectiveness during peak biting times. However, in areas with high mosquito activity, nets can still provide an extra layer of protection, especially for vulnerable populations like infants and elderly individuals.

5. Indoor Sprays and Insecticides: 

Indoor mosquito sprays can help reduce the number of mosquitoes in homes and other enclosed spaces. Eliminating mosquitoes inside living areas reduces the risk of being bitten, particularly in regions with frequent dengue outbreaks.

 

Targeting Mosquito Breeding Grounds

Preventing dengue also requires efforts to control the mosquito population, particularly by targeting their breeding habitats. The ‘Aedes’ mosquito breeds in stagnant water, making it crucial to eliminate potential water reservoirs around homes and communities.

1. Eliminate Stagnant Water: 

Common breeding sites for mosquitoes include old tires, flower pots, water containers, and birdbaths. Regularly cleaning and emptying these containers can prevent mosquitoes from laying eggs and multiplying.

2. Community-Based Efforts: 

Dengue prevention is most effective when approached as a community effort. Support for community-based vector control programs that focus on source reduction—such as clearing debris and covering water tanks—can significantly reduce the mosquito population. In some cases, biological control agents like predatory copepods have been used to reduce mosquito larvae.

3. Improving Sanitation: 

Poor sanitation, inadequate waste management, and post-disaster conditions create ideal breeding grounds for mosquitoes. Hurricanes and other natural disasters, which leave behind rubble and debris, often lead to increased mosquito activity. Prompt cleanup efforts after such events can help curb mosquito proliferation and reduce dengue transmission.

4. Larvicides for Long-Term Control: 

While spraying cities to kill adult mosquitoes is a commonly used method, it is often ineffective for long-term mosquito control. Instead, targeting the larval stage with larvicides and removing larvae habitats is more successful in controlling mosquito populations. These efforts help reduce the number of mosquitoes before they reach adulthood, cutting down on the overall risk of dengue transmission.

Innovations in Mosquito Control

Recent advancements in mosquito control have shown promise in reducing dengue transmission. In 2011, Australian researchers introduced an innovative biological control method. They infected ‘Aedes aegypti’ mosquitoes with a bacterium called ‘Wolbachia’, which prevents the dengue virus from replicating within the mosquitoes. These modified mosquitoes were then released into the wild to breed with the local mosquito population. Over time, more than 80% of the wild mosquito population carried the ‘Wolbachia’ bacterium, resulting in fewer eggs being laid and shorter mosquito lifespans. Field trials of this method are ongoing in countries like Vietnam, Indonesia, and Brazil. If successful, it could offer a sustainable, biological approach to controlling dengue.

 

The Impact of Vaccination on Dengue Control and Prevention

While personal protection and mosquito control are essential, vaccination also plays a crucial role in preventing dengue infections. In recent years, there has been significant progress in developing vaccines against the dengue virus.

1. Dengvaxia (CYD-TDV): 

Developed by Sanofi Pasteur, Dengvaxia is the first vaccine approved for the prevention of dengue infection. It is a live recombinant vaccine that provides protection against all four dengue virus strains. However, it is most effective in individuals who have already been exposed to dengue, offering up to 30% protection against severe illness and hospitalization. The vaccine is administered in three doses, given over 12 months, and has been approved for use in several countries, particularly in dengue-endemic areas.

2. Takeda’s TAK-003 Vaccine: 

Another promising vaccine candidate, TAK-003, is currently being studied. It is based on a live-attenuated dengue serotype 2 virus and has shown effectiveness in protecting against multiple dengue strains. If approved, it could become another tool in the fight against dengue, especially for travelers to dengue-endemic areas.

Conclusion

Preventing dengue infection requires a multifaceted approach that includes personal protection, mosquito population control, and vaccination. By combining these strategies, individuals and communities can significantly reduce the risk of dengue transmission. With ongoing research and innovative solutions, the global effort to combat dengue continues to progress, offering hope for a future with fewer outbreaks and healthier communities.

1. Background of dengue infection
2. Pathophysiology of dengue infection
3. Etiology of dengue infection
4. Prognosis of dengue infection
5. Diagnostic approach for Dengue fever
6. Management of Dengue infection

Management of Dengue Infection

Dengue infection, a mosquito-borne viral disease caused by the dengue virus, is a significant public health concern in many tropical and subtropical regions. The disease ranges from mild, self-limiting dengue fever to severe manifestations like dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), both of which can be life-threatening. Since no specific antiviral treatment for dengue is currently available, the management of dengue focuses primarily on supportive care, close monitoring of symptoms, and prevention of complications.

 

Approach to Dengue Management

Dengue fever is typically a self-limited illness, meaning that it resolves on its own without the need for extensive medical interventions. Supportive care remains the cornerstone of treatment. The primary goals in managing dengue infection are to relieve symptoms, prevent dehydration, detect and manage complications early. Although research is ongoing to develop antiviral drugs that target the dengue virus, as of now, treatment options remain supportive.

 

Supportive Care

The World Health Organization (WHO) provides extensive resources for managing dengue, which largely emphasize supportive care. Patients with dengue fever should rest, stay hydrated, and take medications to relieve pain and fever. Analgesics like acetaminophen (paracetamol) are recommended to reduce fever and alleviate pain. However, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and corticosteroids should be avoided, as they can increase the risk of bleeding complications. These medications affect platelet function and can exacerbate hemorrhagic symptoms in dengue patients.

 

Hydration and Fluid Management

One of the key aspects of dengue management is maintaining proper fluid balance. Oral rehydration therapy (ORT) is advised for patients experiencing dehydration due to high fever or vomiting, which are common symptoms in dengue. ORT helps prevent severe dehydration and can often be managed at home. However, it is important to monitor the patient's condition closely.

Healthcare providers should measure the patient’s platelet count and hematocrit levels daily from the third day of illness until 1–2 days after the fever subsides. If the patient shows signs of dehydration (such as tachycardia, prolonged capillary refill time, cool or mottled skin, or decreased urine output) or if their hematocrit is rising and platelet count is falling, it may indicate worsening of the illness, necessitating intravenous (IV) fluid administration.

For patients with moderate to severe dehydration, IV fluids such as Ringer's lactate or isotonic saline solutions are often administered in a hospital setting. Careful monitoring of fluid intake and output is essential to avoid the risk of fluid overload, especially as patients recover and begin reabsorbing extravasated fluid. Once the hematocrit falls below 40% and the patient shows signs of recovery, IV fluids should be discontinued to prevent complications related to fluid overload.

 

Managing Severe Dengue

Severe dengue, which includes dengue hemorrhagic fever and dengue shock syndrome, requires immediate medical intervention and hospitalization. These conditions can lead to life-threatening complications like plasma leakage, hemorrhage, and organ damage, which are typically observed in the later stages of the disease.

In cases of severe dengue, fluid management becomes critical, and patients may need admission to an intensive care unit (ICU). IV fluid resuscitation should be administered carefully, with boluses of 10–20 mL/kg of isotonic fluids given over 20 minutes. If the patient does not respond to this treatment and the hematocrit continues to rise, it may suggest plasma leakage, requiring plasma expanders like dextran or starch. Starch is often preferred due to fewer hypersensitivity reactions compared to dextran. If hemorrhage or coagulopathy is suspected, blood products such as fresh frozen plasma or platelet transfusions may be necessary.

For patients with internal or gastrointestinal bleeding, blood transfusions might be needed. Close monitoring of urine output, blood pressure, and oxygen levels is essential, and healthcare providers must exercise caution when placing catheters or performing invasive procedures to minimize the risk of bleeding.

 

Criteria for Discharge

Patients recovering from severe dengue or dengue shock syndrome can be considered for discharge when they meet the following criteria:

1. They have been afebrile (without fever) for at least 24 hours without the use of antipyretics.
2. They demonstrate a stable hematocrit level and have had adequate urine output for 48 hours.
3. They show clinical improvement, including an improved appetite and absence of respiratory distress.
4. Their platelet count has increased to over 50,000 cells/μL.

Patients who meet these conditions can generally be discharged safely, although follow-up care is crucial.

 

Dengue in Special Populations

Pregnant Women

Pregnant women with dengue require special attention, as the disease can be more challenging to diagnose due to the overlap of symptoms with conditions like preeclampsia, which also presents with signs such as thrombocytopenia, capillary leakage, and impaired liver function. Pregnant women with dengue should be treated with fluids and acetaminophen to manage fever. However, dengue can pose a serious risk during the third trimester, with maternal death reported in rare cases. If the mother acquires dengue in the peripartum period, newborns should be evaluated for dengue infection through serial platelet counts and serological testing.

 

Children and the Elderly

Children and the elderly are also at greater risk for severe dengue due to potentially weaker immune systems. In these populations, early identification of warning signs—such as dehydration, rising hematocrit levels, or bleeding—can prevent the progression to more severe forms of the disease. Their management is similar to adults but requires careful dosing of fluids and medications to prevent complications.

 

Role of Diet and Activity

There are no specific dietary restrictions for patients with dengue, but hydration is crucial. Patients should be encouraged to drink oral rehydration solutions, water, or fruit juices to maintain adequate fluid levels. A return of appetite is generally a positive sign of recovery, particularly after more severe forms of dengue.

In terms of activity, bed rest is advised during the symptomatic phase of dengue, especially for those suffering from dengue hemorrhagic fever or dengue shock syndrome. Gradual resumption of normal activities can begin as patients enter the recovery phase, but full recovery may take weeks or even months.

 

Conclusion

The management of dengue infection revolves around vigilant monitoring, supportive care, and timely intervention to prevent severe complications. Although the disease is often self-limiting, the potential for progression to life-threatening conditions like dengue hemorrhagic fever and dengue shock syndrome makes early detection and appropriate care critical. Hydration, careful fluid management, and avoidance of certain medications are the foundation of effective dengue management. Additionally, special populations, such as pregnant women and children, require tailored approaches to care. With ongoing research and global efforts to improve dengue control, the outlook for managing this disease continues to evolve.

1. Background of dengue infection
2. Pathophysiology of dengue infection
3. Etiology of dengue infection
4. Prognosis of dengue infection
5. Diagnostic approach for Dengue fever

Diagnostic Approach for Dengue Fever

Diagnosing dengue fever can be challenging due to its nonspecific symptoms, which can mimic other viral or bacterial infections. Therefore, laboratory confirmation is crucial in confirming a diagnosis of dengue. The diagnostic approach includes the following methods:

1. Serological Tests: 

A fourfold or greater increase in immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies in paired serum samples suggests dengue infection. This can be demonstrated through enzyme-linked immunosorbent assays (ELISA) such as:

• MAC-ELISA (for IgM)
• NS1-ELISA (for nonstructural protein 1)
• IgG ELISA

  

2. Molecular Testing (RT-PCR): 

Reverse-transcriptase polymerase chain reaction (RT-PCR) is used to detect the dengue virus's genetic material in serum, cerebrospinal fluid (CSF), or autopsy tissue. It is particularly useful in the early stages of infection and provides a rapid, serotype-specific diagnosis. Unlike serological tests, RT-PCR is not affected by cross-reactivity with other flaviviruses, making it a more reliable diagnostic tool.

 

3. Viral Isolation: 

Though less commonly used, dengue virus can be isolated from blood (serum or plasma), white blood cells, or autopsy samples.

 

Routine Laboratory Tests for Dengue

Several routine tests are critical for assessing the severity of dengue and monitoring for complications:

1. Complete Blood Count (CBC):

• Thrombocytopenia (platelet count < 100 x 10⁹/L) is a common feature of dengue and is often seen before the onset of shock.
• Leukopenia (low white blood cell count) is observed near the end of the febrile phase.
• Hematocrit levels should be monitored regularly, as an increase of more than 20% indicates hemoconcentration and can signal impending shock.

2. Metabolic and Liver Panels:

• Hyponatremia (low sodium) is common in severe dengue cases.
• Liver enzyme elevations (aspartate aminotransferase and alanine aminotransferase) are typically mild but can be elevated significantly in dengue hemorrhagic fever (DHF) with hepatitis.
• Low albumin levels may indicate plasma leakage and vascular permeability.

3. Coagulation Profile:

• Prolonged prothrombin time and activated partial thromboplastin time are indicative of clotting dysfunction, especially in patients with hemorrhagic manifestations.
• Low fibrinogen levels and elevated fibrin degradation products may point to disseminated intravascular coagulation (DIC).

4. Guaiac Test:

This test checks for occult (hidden) blood in stool and may reveal subtle signs of early bleeding in dengue patients.

 

Imaging and Additional Tests

1. Ultrasonography: This imaging modality is used to detect fluid accumulation (pleural effusion, ascites) and is useful for identifying plasma leakage, particularly in DHF. A thickened gallbladder wall is also commonly observed in severe cases.

2. Chest Radiography: X-rays may reveal right-sided pleural effusion, common in DHF and dengue shock syndrome (DSS).

3. Electrocardiography (ECG): While nonspecific, ECG may show changes related to fever, electrolyte imbalances, or medications, though the clinical significance of these changes is unclear.

4. Head CT Scan: In patients with altered consciousness, a head CT scan without contrast can help detect intracranial hemorrhage or cerebral edema, which may occur in severe dengue cases.

 

Serologic and PCR Testing

Early in Illness (First 5 Days): Laboratory confirmation is best achieved by detecting dengue virus genomic sequences via RT-PCR or NS1 antigen via immunoassay from a single acute-phase serum sample.

Later in Illness: Detection of IgM anti-DENV via ELISA is recommended after the first week of symptoms. The Centers for Disease Control and Prevention (CDC) advises using a combination of RT-PCR or NS1 antigen tests and IgM testing to confirm dengue infection, depending on the timing of symptom onset.

 

Classification and Reporting

Cases of dengue are classified as:

• Suspected Dengue: If symptoms align with the clinical description.
• Probable Dengue: If there are supportive serologic findings (positive IgM, hemagglutination-inhibition antibody titer > 1280).
• Confirmed Dengue: If laboratory confirmation is achieved.

In severe cases of dengue (hemorrhagic or shock syndrome), it’s essential to report the case to public health authorities, including details like patient demographics, recent travel history, and outcomes.

 

Conclusion

A comprehensive diagnostic workup for dengue includes a combination of serologic tests, molecular testing (RT-PCR), and routine laboratory evaluations. Ultrasonography and coagulation studies are essential for identifying complications like plasma leakage, while timely monitoring of hematocrit and platelet levels is crucial for detecting early signs of severe dengue, including hemorrhagic fever and shock.

Similar posts:

• Background of dengue infection

• Pathophysiology of dengue infection

• Etiology of dengue infection

• Prognosis of dengue infection

• Management of Dengue infection

Patient Education and History: Understanding Dengue Fever

Dengue fever is a mosquito-borne viral illness caused by the bite of infected ‘Aedes’ mosquitoes, commonly found in tropical and subtropical regions. Individuals, especially those who have previously contracted dengue fever, must understand the importance of preventive strategies and the heightened risk of subsequent infections. A second exposure to a different strain of the virus increases the likelihood of developing more severe conditions, such as dengue hemorrhagic fever or dengue shock syndrome.

Patient Education: Preventing Mosquito Bites and Dengue Fever

One of the most effective ways to prevent dengue fever is by avoiding mosquito bites. This is particularly important for individuals who have previously experienced dengue fever, as they are at a higher risk of developing severe complications if they contract a different strain of the virus.

Key preventive measures include:

1. Using Mosquito Repellents: Apply mosquito repellents containing DEET, picaridin, or oil of lemon eucalyptus to exposed skin and clothing.
2. Wearing Protective Clothing: Long-sleeved shirts, long pants, socks, and shoes help reduce skin exposure.
3. Installing Window and Door Screens: Ensure your home is equipped with intact screens to keep mosquitoes out.
4. Sleeping Under Mosquito Nets: Use mosquito nets, especially when sleeping in areas without screened windows or air conditioning.
5. Eliminating Standing Water: Mosquitoes breed in stagnant water, so regularly check and empty containers that collect water, such as flower pots, buckets, and tires.
6. Using Permethrin-Treated Clothing and Gear: If traveling to a dengue-endemic area, consider treating your clothes, shoes, and camping gear with permethrin for extra protection.

When traveling to regions where dengue is common, it is crucial to take these precautions seriously. Dengue is endemic in many parts of the world, including Southeast Asia, Latin America, and parts of Africa. Travelers should check the latest information on dengue outbreaks through reliable sources like the US Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO). These platforms offer real-time updates on dengue risks and outbreaks, helping travelers plan their preventive strategies more effectively.

 

Risk of Severe Dengue

Individuals who have already had dengue fever are at higher risk of severe complications if they are infected again with a different strain of the virus. Dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) are the most severe forms of the disease, leading to life-threatening situations if not properly managed.

Dengue Hemorrhagic Fever (DHF): A serious condition characterized by plasma leakage, hemorrhage (bleeding), and low platelet counts.

Dengue Shock Syndrome (DSS): A more critical progression of DHF, leading to circulatory failure, which can be fatal if not treated properly.

This risk of severe dengue makes it all the more important for individuals, especially those with prior dengue exposure, to follow preventive measures rigorously.

 

History: Recognizing Dengue Fever Symptoms

The history of a patient who may have dengue fever often involves living in or recent travel to a dengue-endemic region. The virus has an incubation period of 3 to 14 days, with an average of 4 to 7 days. This means symptoms usually develop within a week after being bitten by an infected mosquito. If symptoms appear more than two weeks after leaving an endemic area, it is unlikely to be dengue.

Patients often experience a prodrome (early symptoms) of:

• Chills
• Reddened or mottled skin
• Facial flushing

Facial flushing is a particularly sensitive and specific early indicator of dengue fever. This stage generally persists for a duration of 2 to 3 days.

 

Symptoms of Dengue Fever

Classic dengue fever begins suddenly with a high fever, chills, and intense pain, which is often described as "breakbone" pain due to its severity. Other symptoms may include:

1. Fever (up to 41°C or 105.8°F)’’, lasting 2-7 days
2. Severe headache
3. Pain behind the eyes (retro-orbital pain)
4. Muscle and joint pain (myalgias and arthralgias)
5. Nausea and vomiting (although diarrhea is rare)
6. Weakness and fatigue
7. Loss of appetite (anorexia)
8. Sore throat
9. Altered taste sensation
10. Mild bleeding symptoms (e.g., gum bleeding, nosebleeds, menorrhagia in women, or blood in urine)
11. Rash: A maculopapular (flat and raised) or confluent rash often appears on the face, thorax, and limbs by Day 3 of the illness. The rash may last for 2-3 days.

In children younger than 15 years, the presentation may be different. They often develop a nonspecific febrile illness, sometimes with a rash, rather than the classic severe form of dengue seen in adults.

 

Recovery and Complications

The fever usually subsides as the virus is eliminated from the bloodstream, although in certain cases, especially in children, it may briefly reappear in what is known as "saddleback fever." After the fever breaks, some individuals might experience a second rash that is more extensive and resembles a measles-like appearance. This rash can persist for 1 to 5 days and may be accompanied by peeling skin.

Recovery from dengue fever can be slow, with lingering fatigue and exhaustion even after the fever subsides. This post-fever recovery phase may last up to two weeks or longer in some cases.

However, at the time of defervescence, there is a critical window where patients are at risk for developing DHF or DSS. Signs that dengue is progressing to a severe form include:

1. Abdominal pain
2. Restlessness
3. Changes in mental status
4. Hypothermia (abnormally low body temperature)
5. A sudden drop in platelet count

Without timely treatment, DHF can lead to DSS, marked by circulatory collapse, and potentially fatal complications. Symptoms of impending shock include persistent vomiting, severe abdominal pain, and restlessness.

 

Conclusion

Understanding the history and progression of dengue fever is essential for effective patient care and prevention. Educating patients, particularly those with a history of dengue, about the importance of mosquito bite prevention is crucial to reducing the risk of infection and severe complications. Early recognition of symptoms and appropriate medical care can prevent the progression of dengue fever to its more dangerous forms. Always consult reliable sources such as the CDC and WHO for the latest updates on dengue outbreaks and prevention strategies.

1. Background of dengue infection
2. Pathophysiology of dengue infection
3. Etiology of dengue infection
4. Prognosis of dengue infection
5. Diagnostic approach for Dengue fever
6. Management of Dengue infection

Prognosis of Dengue infection

Prognosis of Dengue infection

Dengue fever is generally a self-limiting illness, meaning it resolves on its own in most cases. The prognosis for patients with dengue fever is favorable, with a mortality rate of less than 1%. Most individuals recover fully and develop long-lasting immunity to the specific serotype of the virus that caused the infection. However, the prognosis becomes more complex when dengue progresses to its severe forms, such as dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS).

 

Mortality Rates and Severity

The mortality rate for dengue hemorrhagic fever (DHF) varies significantly depending on whether the condition is treated. When appropriate medical care is provided, the mortality rate for DHF is between 2% and 5%. In contrast, untreated DHF can have a mortality rate as high as 50%, emphasizing the critical importance of timely diagnosis and treatment. Severe dengue cases can be life-threatening, but survivors usually recover without long-term complications.

In severe dengue outbreaks, the fatality rate can differ by country. For example, during the 1997 Cuban epidemic, the fatality rate for patients who met the criteria for severe dengue was approximately 6%. This contrasts with the mortality rate for uncomplicated dengue fever, which is consistently less than 1%. One challenge in assessing the true burden of dengue is the large number of asymptomatic or mild cases. Data from the same Cuban epidemic indicated that for every clinical case of dengue fever, approximately 13.9 cases went unrecognized due to minimal or absent symptoms.

 

Factors Influencing Prognosis

Several factors can affect the severity of dengue infection and, consequently, the prognosis for affected individuals. These include:

• Patient age: Young children, especially those under 15, are more susceptible to severe dengue, particularly in areas where dengue is endemic.
• Pregnancy: Pregnant women with dengue are at higher risk for severe complications, including preterm birth and, in some cases, maternal mortality.
• Nutritional status: Malnutrition can weaken the immune system, increasing the risk of severe outcomes from dengue.
• Ethnicity: Genetic factors may play a role in how the immune system responds to dengue, potentially influencing disease severity.
• Sequence of infection with different serotypes: A primary infection with one serotype followed by a secondary infection with a different serotype increases the risk of severe dengue due to antibody-dependent enhancement (ADE).
• Virus genotype: Some genotypes of the dengue virus may be more virulent than others, contributing to the severity of the disease.
• Quality and availability of medical care: Access to timely and effective treatment is crucial for improving outcomes in severe cases of dengue.

You should also Know about

• भोजन का इतिहास और उसकी संरक्षण प्रक्रिया
• Traditional food and their importance, Role of food fortification, Aspects of "Eat right" Challenges in India, Tribal foods of Madhya Pradesh.
• भोजन के घटक: कार्बोहाइड्रेट, प्रोटीन, वसा, विटामिन, खनिज और एंजाइम - रासायनिक संरचना, वर्गीकरण एवं कार्य

Predictors of Poor Outcome

A review of 14,209 dengue patients in Singapore identified several factors that could predict death from severe dengue. These included atypical presentations, significant comorbid illnesses, abnormal serum markers (such as low albumin levels or abnormal coagulation studies), and secondary bacterial infections. Identifying these factors early in the course of the disease can help healthcare providers deliver more targeted care, improving patient outcomes.

 

Complications and Long-Term Effects

While most people who recover from dengue do not experience long-term complications, there are some rare but serious complications associated with the infection. These may include:

• Cardiomyopathy (heart muscle damage)
• Seizures, encephalopathy, and viral encephalitis (brain inflammation)
• Hepatic injury (liver damage)
• Depression (post-infection)
• Pneumonia (lung infection)
• Iritis (inflammation of the eye)
• Orchitis (inflammation of the testicles) and oophoritis (inflammation of the ovaries)

In cases of dengue hemorrhagic fever, around 20-30% of patients develop dengue shock syndrome (DSS), a life-threatening condition characterized by a sudden drop in blood pressure. This condition demands urgent medical attention to avoid life-threatening consequences. Globally, 90% of dengue hemorrhagic fever cases occur in children under 15 years of age, although in the Americas, both children and adults can be affected.

 

Economic and Social Impact

Beyond the health effects, dengue fever also imposes a significant economic burden, particularly in low-income countries. The economic costs of dengue include direct medical expenses, such as hospitalization and treatment, as well as indirect costs like lost workdays and school absences. A study of 1,695 pediatric and adult patients across eight countries found that the average illness duration was nearly 12 days for both ambulatory and hospitalized patients. Students who were hospitalized missed an average of 5.6 days of school, while employed patients lost nearly 10 workdays on average.

The mean cost of illness from dengue was more than double for hospitalized cases compared to outpatient cases, amounting to approximately 1,394 international dollars (I$). Given the high incidence of dengue worldwide, with an estimated 594,000 cases annually, the aggregate economic cost of dengue is substantial, exceeding I$587 million, not including the costs of underreporting, surveillance, and vector control efforts.

Conclusion

• The prognosis for dengue fever is generally positive, with a mortality rate of less than 1%, and most patients recover fully with immunity to the specific serotype. However, severe cases like dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) can be life-threatening, with untreated DHF carrying a mortality rate of up to 50%. 
• Risk factors for severe outcomes include young age, pregnancy, malnutrition, and secondary infections with different serotypes. Timely medical care significantly improves survival in severe cases. While long-term complications are rare, dengue can occasionally cause liver, heart, or neurological issues.
• Dengue also imposes a significant economic burden, particularly in low-income regions, due to healthcare costs and lost workdays. Early intervention and preventive strategies are key to improving outcomes.

Similar post

1. Background of dengue infection
2. Pathophysiology of dengue infection
3. Etiology of dengue infection

भारत में तंबाकू और सुपारी से जुड़े वैश्विक मुंह के कैंसर के मामलों की संख्या सबसे अधिक

भारत में तंबाकू और सुपारी से जुड़े वैश्विक मुंह के कैंसर के मामलों की संख्या सबसे अधिक: Lancet study

 

हाल ही में किए गए एक "लैंसेट अध्ययन" ने दक्षिण एशिया, विशेष रूप से भारत में, बिना धुएं वाले तंबाकू और सुपारी (जिसे पान सुपारी के नाम से भी जाना जाता है) के सेवन से जुड़े बढ़ते स्वास्थ्य जोखिमों पर चिंता व्यक्त की है। सुपारी उद्योग द्वारा पान मसाला को माउथ फ्रेशनर के रूप में प्रचारित करने के लिए बॉलीवुड सितारों को शामिल करने के बावजूद, इस अध्ययन में खुलासा हुआ है कि भारत दुनिया में तंबाकू और सुपारी के उपयोग से होने वाले मुंह के कैंसर के मामलों में सबसे आगे है।

 

2022 में, "इंटरनेशनल एजेंसी फॉर रिसर्च ऑन कैंसर (IARC)" की रिपोर्ट के अनुसार, भारत में "120,200 वैश्विक मामलों" में से "83,400" मामले बिना धुएं वाले तंबाकू और सुपारी के उपयोग से जुड़े थे। अध्ययन ने इस बात पर प्रकाश डाला कि सुपारी और विभिन्न प्रकार के बिना धुएं वाले तंबाकू जैसे गुटका और खैनी का सेवन गंभीर स्वास्थ्य परिणामों का कारण बनता है, और यह देशभर में आसानी से उपलब्ध हैं।

 

अध्ययन के अनुसार, भारत में महिलाओं में मुख्य रूप से "सुपारी (30%)" और "तंबाकू के साथ पान (28%)" के कारण मुंह का कैंसर हुआ, इसके बाद "गुटका (21%)" और "खैनी (21%)" का नंबर आता है। पुरुषों में, "खैनी (47%)" और "गुटका (43%)" प्रमुख कारण थे, इसके अलावा "तंबाकू के साथ पान (33%)" और "सुपारी (32%)" भी योगदान देते हैं। IARC वैज्ञानिक "डॉ. हैरिएट रमगाय" ने इन उत्पादों से होने वाले गंभीर स्वास्थ्य बोझ को रेखांकित करते हुए इनके सेवन को कम करने के लिए प्रभावी रोकथाम रणनीतियों की आवश्यकता पर जोर दिया।

 

दक्षिण एशिया, विशेष रूप से भारत में, मुंह के कैंसर की दरें इन हानिकारक उत्पादों की आसान उपलब्धता और आक्रामक विपणन के कारण बढ़ गई हैं। टाटा मेमोरियल सेंटर, नवी मुंबई के जाने-माने हेड और नेक कैंसर सर्जन और अध्ययन के सह-लेखक 'डॉ. पंकज चतुर्वेदी' ने इस बढ़ते संकट से निपटने के लिए व्यापक जनस्वास्थ्य नीतियों की जरूरत पर जोर दिया। उन्होंने चेतावनी दी कि सुपारी "सबम्यूकस फाइब्रोसिस" के अलावा, लाइलाज मुंह के कैंसर का कारण बनती है, जिससे युवा लोग प्रभावित होते हैं और परिवारों पर आर्थिक और भावनात्मक रूप से भारी बोझ पड़ता है।

 

हालांकि भारत ने पहले गुटका जैसे उत्पादों पर प्रतिबंध लगाया है, लेकिन इन उपायों के क्रियान्वयन में कमजोरी रही है, जिससे तंबाकू उद्योग को हानिकारक गतिविधियां जारी रखने की अनुमति मिली है। यह अध्ययन इस क्षेत्र में बढ़ते मुंह के कैंसर संकट को रोकने के लिए बेहतर नियमन, जन जागरूकता अभियान और सामूहिक प्रयासों की तत्काल आवश्यकता की ओर इशारा करता है।

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• भारत में तंबाकू और सुपारी से जुड़े वैश्विक मुंह के कैंसर के मामलों की संख्या सबसे अधिक: Lancet study